APRIL 26, 2018
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PROJECT UPDATE: EXPANDING PARAMEDIC ABILITY ON SCENE WHAT ARE WE TRYING TO ACCOMPLISH? Develop patient care protocols that reduce unnecessary patient transports by 27% by 6/1/2017. GENERAL DESCRIPTION • This project will result in the recommendation for future processes. • Operating definition of unnecessary transport: transport of a patient who has a GCS≥14; has not received nitrous, fentanyl, or versed; and is presenting in a low-acuity condition • Operating definition of Unit Hour Utilization (UHU): number of transports over hours produced REASON FOR THE EFFORT • The Agency’s transport volume has grown at a rate of 29.6% with 40.2% growth in priority 3 patients over the last 5 years. This growth is unsustainable in our current model. • The Reducing Unnecessary Patient Encounters work team determined that in calendar year 2015, approximately (58,781) patients were determined to be low-acuity, eligible for means of alternate transport and/or destination. A retrospective study of patients performed by care providers, deemed 50.9% of patients were classified as an “unnecessary transport” and could be in enrolled in an alternative transport/destination protocol.
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PROJECT GOALS • Reduce unnecessary patient transports by 27% • Evaluate the current process for low acuity/ unnecessary transport patients • Development of a tool that would promote shared decision making for transport decisions • Test the tool • Implementation of the tool to include a “ramp style” educational structure WHERE ARE THEY NOW??? A patient care protocol was developed by this team to allow low acuity patients to directly engage and have a voice in their healthcare options. Under close supervision by the Medical Director and EMS Fellow, eleven paramedics began discussing alternative options to ambulance transport with eligible patients. Early feedback has been positive; this protocol has been well received by patients and providers. So far, our results indicate this is a low risk protocol. In testing, it has been effective in identifying eligible and appropriate patients. Next steps are to increase enrollment so that more patients may benefit from this program. Group interviews were recently conducted with our test paramedics to identify opportunities to improve the protocol. We hope to expand to additional providers soon! For more information, please email Allison Infinger at allisoni@medic911.com.
PERIOD 3 (3/1/18 - 6/30/18) WEEKLY RESULTS THRU’ 4/20/18
EST. PAYOUT : $0 FINANCIAL STANDING VS. BUDGET (GOAL: > 0.25%)
QUALIFYING CRITERIA Budget, Patient Satisfaction and Total Task Time goals must be met to turn on Performance Pay. If one of these three goals is not met, Performance Pay will not be paid.
OFF TARGET
PATIENT SATISFACTION RATED AS “EXCELLENT” 70%
(GOAL: > 50%; LOW: 50%-59%; MID:60%-64%; HI: > 65%)
TOTAL TASK TIME
66:48
(GOAL: < 70:00; LOW: 69:00-70:00; MID: 68:01-68:59; HI: < 68:00)
$0
$150 $300
$0
$150 $300
AGENCY DRIVER SAFETY SCORING AVERAGE (GOAL: > 8%) 9
PERFORMANCE CRITERIA ($100 EA.)
CMED MPDS HIGH COMPLIANCE (GOAL: > 70%) 75%*
RESPONSE TIMES P1: 96.80%/P2: 95.45% (GOAL: P1, P2: > 90%; P3: > 85%) P3: 91.56%*
P1 TRAUMA SCENE TIMES (GOAL: < 10:00) 10:03 *Response Times and MPDS as of 4/16/18
The latest Performance Pay Tracking Period began on March 1. We are striving to meet the Patient Satisfaction goal of a ≥ 50% rating (experience as “Excellent”). In order to create a comfortable margin of performance, while continuing to improve the patient experience, we would like to share some feedback from recent patient focus groups. The two areas that patients value the most are: 1. Communication from the treating crew: “Explain treatment options and procedures” “Provide reassurance and compassionate communication with the patient” 2. Setting clear expectations: “Set transport length expectation” “Set a triage level expectation before arriving at the hospital”
SEPTEMBER 2014
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Every month, Medic provides a written Agency update to key stakeholders including the Board of County Commissioners, the County Manager’s office and the Agency’s Board of Commissioners; it is referred to as the Board Bulletin. This one page communication is comprised of six charts representing key performance indicators specifically chosen for this audience coupled with a brief narrative aimed at conveying Medic related news.
Following is Medic’s Board Bulletin for the month of March. This month’s narrative is focused on the ongoing move process, with an aim of assuring Agency stakeholders that continuity of service to this community was fully maintained throughout this complex endeavor – thanks in large part to outstanding planning and execution by the men and women who choose to make Medic’s mission their own. Enjoy!
NEW HEADQUARTERS’ RIBBON CUTTING Mecklenburg County officials, Medic employees and members of the local community celebrated Medic’s new 181,073 sq. ft. facility with a ribbon cutting on March 21, 2018. Among the over 150 attendees were County Manager Dena Diorio along with County Commissioners Ella Scarborough, Vilma Leake, Trevor Fuller, George Dunlap and Jim Puckett. Medic’s Agency Board of Directors was also well represented, as were numerous county and city leaders. Following the ceremony, Medic’s $48.3 million facility was opened to attendees through employee led tours. Guests had the opportunity to view the state of the art training facility, the Agency’s 911 dispatch center, and the 10 bay fleet building. The tour emphasized the headquarters’ improved operational efficiencies in addition to the tremendous flexibility it provides Medic for growth and adaptation well into the future. MEDICARE SUPPORT Due to the delayed passage of the Bipartisan Budget Act of 2018, several provisions related to reimbursement for ambulance services were temporary suspended. This resulted in a 2% increase in urban based Medicare reimbursement for providers until subsequent legislation reinstated the prior fee structure. Knowing this, Medic chose to hold all existing Medicare claims until the pending legislation was signed into law. The intent of this decision was to prevent the need to refund Medicare patients as a result of the passage of the bill. This eliminated the need for costly rework by Medic’s billing department while simultaneously easing the burden associated with processing multiple refunds for service. Medic released its claims on March 8, 2018 after the final rate was approved. REV. BILLY GRAHAM SUPPORT Planning and preparedness are critical components of Medic’s ability to meet the myriad of responsibilities the Agency fulfills in our community. Medic has worked with city, county and state officials through the years on plans for supporting a funeral for Reverend Billy Graham. Unfortunately these plans were put into motion the week following his death on February 21. The funeral was a national security level event due to the numerous high ranking political figures who attended, including President Trump and Vice President Pence. Medic was able to successfully implement its plan to meet the staffing requirements for Reverend Graham’s funeral while simultaneously meeting the EMS system’s needs for a busy Friday.
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CONTEXT FOR KEY PERFORMANCE INDICATORS The data on the following page is presented in control charts. Each dot represents a monthly average, count or proportion. The middle green line is the average performance for the displayed periods, while the red lines are the upper and lower control limits. • Response time compliance performance goal is 90%. • Cardiac arrest survival is measured for patients that meet a nationally standardized case definition. • Patient satisfaction is determined using a random telephone survey of up to 200 transported patients per month. This results in a proportion which rated their overall quality of care as excellent. The target is > 65% excellent. • County cost per transport is based off of the total number of transports in a month divided by the monthly subsidy provided to Medic.
SEPTEMBER 2014
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COMPLIANCE CLASS TRAINING In order to successfully complete this LMS training, please be aware of the following: Passwords and Login It is your responsibility to ensure that you have access to the Success Factors Learning Management System (LMS). You will need to log into the LMS to complete your compliance training and to set up your fit testing/TB test, if applicable. If you have never logged into the LMS then you will do the following: • Go to: https://medic911.plateau.com • User ID: Employee ID number with preceding zeros if applicable • Default Temporary Password is: ‘medic911’ If you have forgotten your password please use the “forgot password’ function. If that fails then contact Medical Services at eqs@medic911.com. Password resets will only occur during business hours • You must be sure that you have your correct
login information before attempting to complete work in the lab For complete instructions, visit https://www.medic911.com/extranet/my-medic/corporate-compliance If you have Corporate Compliance content questions, contact Pam Jackson at pamelaj@medic911.com. For technical questions, contact Medical Services at eqs@medic911.com ATTENDEES Jose Aguilar-Castillo, Daniel Baltimore, Lukas Biebinger, Nickolas Bringolf, Amy Broughton, Ty Brown, David Brown, Audrey Danko, Dena Gaston, John Gibson, Jeff Glenn, Jose Gonzalez, Daniel Hagemeyer, Charles Horne, Jeffrey Lineberger, Tim Marshburn, Randy McKown, Veronica Michaelis, Shelly Miller, David Moore, Arthur Nolan, Don Overcash, Tony Pattillo, David Phillips, Beth Rimmer, Don Shue, Barry Thornton, Deanna Vandeventer, Charles Voglewede and Tom Wright.
May 2018
• In-service dates coming soon. • Calendar week starts on Monday. Monday
Tuesday
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INSERVICE - 1000
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INSERVICE - 1600
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INSERVICE - 1000
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MEMORIAL DAY ADMIN OFFICES CLOSED
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Saturday
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SAFETY MEETING 1300 - 1500
Sunday 5
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ASSESSMENT CENTER
SAFE TEEN
0800 - 1700
0700 - 1300
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PROTOCOL CLARIFICATIONS Please review the following information for protocols dated 04/01/2018: 1. When placing the defibrillation pads in an A/P position, the anterior pad should be placed slightly off center to allow for continued use of the qCPR device. 2. If 5 epinephrines have been administered and ROSC is obtained but then lost, Medical Control should be contacted for additional doses of epinephrine. 3. If ROSC is obtained on scene but the patient loses pulses prior to moving to the ambulance treatment should resume from where ROSC was obtained. Depending upon the situation, transport may or may not be indicated. Medical Control should be contacted to determine best course of action. 4. Medical control should be contacted for pronouncing patients who are without pulses and previously had ROSC 5. For blunt and penetrating traumatic arrests – the time to hospital clock (5 mins for blunt arrest; 15 mins for penetrating arrest) starts at time of arrest. Consider all factors when determining transport time, i.e. distance, traffic, need for extrication, location etc. 6. An allergy to sulfa is not a contraindication for sodium thiosulfate. 7. The breakpoint for administering sodium thiosulfate is AMS/Confusion/Unconsciousness. 8. Code stroke is now defined as symptoms less than 24 hours. We will transport these patients in an emergent fashion as we have with all other code strokes in the past. 9. The 5 epinephrine max does not apply to pediatric cardiac arrests. However, Dr. Swanson encourages providers to make contact with medical control prior to a 6th dose for consultation. Please contact Trevor Taylor with any further questions at trevort@medic911.com MEDIC RETIREE: CAROL TOMS Scheduling Specialist Carol Toms, a Medic Unsung Hero award receiptient, is retiring May 1. Now in her 11th year at Medic, Carol was instrumental in developing the scheduling processes that helped balance employee satisfaction with the needs of the system. Even though Carol retires in May, her influence on Medic will continue for years to come. Best wishes Carol! For more informaiton, email Bryan Runyan at bryanr@medic911.com
HR UPCOMING EVENTS We’ve moved into our new home; now we can start making new memories! First, we are excited to celebrate EMS Week 2018 - our first here on Wilkinson - May 21st - 24th. As usual, this week will provide lots of opportunities to eat delicious food, spend time with co-workers, eat more delicious food, get cool prizes, and (did we mention?) eat delicious food. Lots of teams including Public Relations, Human Resources, Facilities and Logistics will work together to
make this one memorable. Secondly, your Human Resources team is already planning our 2018 Health Fair for October 16th - 17th. We are investigating ways to make it even better, particularly with our increased space. We will communicate much more in the coming months. Finally, your Public Relations team is making plans for the 2018 Night of Honor, an excellent event providing you a welldeserved night in the spotlight. The Night of Honor is a special
opportunity to share with your family members and co-workers, being recognized for your hard work, for making a difference with our patients and our community. Look for more info on the 2018 Night of Honor which will be in the late summer/early fall. Mark your calendars for these events, we look forward to seeing everyone!
SEPTEMBER 2014
For more information, email humanresources@medic911.com.
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MARCH COMMENDATIONS Jacob Abell, Jared Absher, Jose Aguilar-Castillo, Anna Ailstock, (2), Benjamin Astrike (3), Jacob Atkinson, Daniel Baffaro (2), Jeff Bailey (4), Jennifer Bailey, Lester Bailey (8), Joshua Baissana (2), Mian Baker (4), Josiah Balbuena (3), Anna Baldwin, Mark Baumgarten, Joshua Baun (2), Stephanie Benson, Kyle Bielan (3), Eric Bitler (4), Robert Bivens (2), Thomas Black, Max Bolgrin, Nina Bost, Maryam Boyd (2), Daniel Boyer (2), Angela Breeden-Alvarez, Casey Brennan (2), Nickolas Bringolf (4), Allison Brinzey (4), Veronica Brittain (2), Dalton Burleson, Paul Burns (3), Tabitha Byers (3), James Camarena (6), Matthew Campbell, Michael Campbell (5), Kristin Carriker (3), Anne Carter (2), Kevin Carter (2), Nicholas Chase, Carrie Church (2), Stephen Church, Meghan Clark, Philip Clark (3), Ryan Clark (6), Braxton Clarke (2), Heather Clay, Erin Clemens (2), Ieshia Clyburn, Cory Colvin (2), Michael Conklin (2), Kathleen Connell, Harley Conrad III (4), Curtis Cooper (2), Jennifer Cordero, Dale Cordice, Katherine Cornelius, Amanda Crago, Hunter Cromwell, Rebecca Crone, Meagan Crowson (4), Caleb Crum, John Crunk, Victoria D’Ambrosio, Matthew Deedrick (2), Kennedy Deese (4), Laura Dellinger, Jennifer Dollar (4), David Dombo (2), Gabriel Donaldson (3), Marissa Donnelly (3), Shauna Downs (5), Mariann Earwood, Alexandra Ebner (4), Ruben Echeverry, Yolanda Edmonds (3), Charles Edwards (2), Theodore Elias (2), Dustin Elliott, Shawn Elliott (4), Jacob Ellison (2), Emma Engberg, Marissa Epps (4), Donald Eslick (3), Robin Farrar, Anthony Ferrante, Nicholas Fiedler, Stephanie Fisher (5), Miguel Flechas (5), Marshall Fletcher (3), Scott Forbes, Christian Fulenwider (3), Kathryn Furphy (3), Jenna Galanti, Dena Gaston, Robin Geck (4), Daniel Geis (2), Michael George (2), David Gerig, William Gibson, Kyle Gilliam, Candace Gilliland, Jeffrey Glenn (3), Robert Glover (3), Noah Godbey (3), Matthew Godec, Rogelio Gomez, Jose Gonzalez, Randolph Goodman (4), Bailey Goodyear, Robert Graf, Rheba Graham-James, Mali Green, Timothy Greene (3), Carl Greene II (2), Eric Hall, Rebecca Hamilton, Bret Hannah, Robert Harford (5), Russell Harrell, Benjamin Harris (2), Brittany Harris (3), Isabella Hayes (2), Stephen Hayes (2), Alyssa Head, Jasmine Headen , Nicholas Heasley (4), Shannon Helms (2), Ryan Hengstler (3), Shaun Heptinstall (2), David Hewitt , Samantha Hiott (3), David Hodnett (3), Nicole Hogan, Aaron Hopping , Samuel Hord, Charles Horne, Kathy Houston, Nicholas Howard (4), Eric Hudspeth (2), John Hunt (3), Ethan Ivey, Jason Jeffares, Christopher Jerrell (5), Angela Johnson, Tiffany Johnson, Trueman Jones, Casey Jordan (6), Catherine Jordan, Austin Joseph (2), Jeffrey Karll (2), Angela Kaufman (5), Elizabeth Kennedy (2), Ethan Kenney, Shawn Kerley (2), Mark Kern (3), Irina Kerusenko (3), Madison Kiger, David Kilguss, Jamaar Knowlden, Eric Koelbl, Jonathan Konecny (8), John Kraynik,
Christopher Lamb (3), Jackson Langevoort, Calvin LaVictoire (2), Megan Lawless, Shellye Ledbetter, (2), Lance Lee (3), Amy Leirmoe (2), John Leopard (5), Kaitlin Lewis (2), Matthew Lewis (3), Jeffrey Lineberger (2), Julio Lizarazo (2), Kenneth Lockard (2), Meriwether Lyman (2), Michael Macho (3), Antonia Macklin, Holly Maggard, Mikhail Makarov (3), Elizabeth Maki (4), Mary Malinowski, Taylor Marcus (2), Timothy Marshburn, Sarah Maw, Anna McCarley (2), Kelly McCarthy (4), Gabriel McGaha, Randall McKown (3), Christopher McNally (5), Matthew McPherson (3), Milan Merges (5), Brian Miller (2), Casey Miller, Chelsea Miller, Jacob Miller (4), Michael Miller, Hunter Mitchell (2), Matthew Mohr, Mary Moore, Michael Moore, Eric Morrison, Thomas Muhammad, Brian Murphy, Jeremy Murphy (10), Jacob Nelson (3), Barry Nixon, Arthur Nolan (4), Christopher Noll, Tyler North (3), Brian Norton, Oluwafemi Opelami (2), Karl Ottesen (3), Robert Owens (3), Ethan Parker (3), Macon Parker (4), Alex Patrone (2), Eli Patterson (4), Jamal Peay (2), Albert Pendlay (3), Aaron Peppel, Joshua Perch, Alexis Perkel, Michael Perrott, Amelia Pethel (2), Chassity Phillips (3), David Phillips, Christopher Pinto (5), Howard Pittman, Michael Pomeroy (2), Heber Portela Da Rosa, Jeffery Potter, Ryan Powell (2), Jason Queen (4), Roberto Rabell (6), Matthew Raborn, William Ramsey, Christine Ranjit (2), Marcus Ray, Christopher Reazer, Alex Reed (3), Helen Reed (2), Christopher Reinig, David Reynolds (2), Adamo Riascos (2), Lucius Rice (2), Brandis Ridenhour (2), Michael Rider (2), Jose Rivera (5), Gary Rizzo, Hakiym Roach, Sydney Robertson, Stephen (2), Charles Robinson, Laura Rohrer (2), James Roinick (2), Amanda Rothbauer, Emil Ruiz (2), John Ryan (2), Teighlor Sain, Michael Santeramo (2), Michael Schaupp, Michael Schmidt, Addison Schroeder (5), Amanda Scoggin (2), Derek Scott, Victoria Searcy, Venetia Seegars, Benjamin Shaw (3), Kyle Sheehan (2), Karen Sherard (2), Michael Sherriff, Jacob Shope (3), Aaron Shreffler, Jennifer Slagle (3), Andrew Smith, Ashley Smith (3), Heather Smith, Lindsay Smith (2), Robert Smith (3), Stacen Smith (2), Tyler Smith, Jordan Sneed (9), Matthew Soria (4), Craig Sovinsky (7), Emily Spicer, Chandler Spires, Gene Starnes (4), Matthew Stegall (2), Richard Steinbroner (3), Michael Stratton (3), Mark Strother, John Stroup, Jason Swick, Benjamin Thackston (2), Adam Tolman, David Toney (2), Maureen Townes, Gregory Truesdell, Jeffrey Tumas (3), Douglas Valot (2), Jonathan Varalli (2), John Wagner (6), Andrew Walker (2), Michael Walker (3), Shane Walker (2), Kiara Warren, Nichole Washington, Rebecca Wearmouth, Christopher Weber, Emily Webster (5), John Wenham, Jennifer White (4), Tonya Whitesides (2), James Wilkinson (2), Jeffrey Williams (2), Travis Williams (5), Melissa Wills (4), Scott Wilson, Joan Wisham, Jesse Wolfram (3), Matthew Wood (2), Michael Wunsch Jr (2) and Kent Young (5).